Benign Tumors

Benign Tumors of the

Ovaries and Fallopian

Tubes

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Differential Diagnosis of Ovarian Tumors

Pathogenesis Specific Type

Functional Follicular Cysts

Lutein Cysts

Theca-lutein cysts

Inflammatory Oophoritis

Salpingo-oophoritis

Metaplastic Endometriosis

Neoplastic Epithelial

Sex Cord-Stromal

Germ-Cell

Introduction

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high gonadotropin Theca-lutein cysts (ovulation induction) (hydatidiform mole) (invasive mole) (choriocarcinoma)

PathogenesisFunctional Ovarian Tumors

ovarian follicle follicular cyst

corpus luteum lutein cyst

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lutein cyst:

Clinical Features

Functional Ovarian Tumors

asymptomatic,unilocular, < 6 cm in diameter,regress

ovarian follicle cyst:

more firm / solid ， delay period

undergo torsion: pain, tenderness and rebound ten-derness, moderate leukocytosis.

rupture: pain, tenderness, hemoperitoneum.

Theca-lutein cyst: high gonadotropin level, bilateral (10-15 cm) ， regress

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Diagnosis


Presumptive Diagnosis: 4 to 8 cm cystic adnexal mass is noted on bimanual examination mobile, unilateral, no ascites, < 8 cmConfirmed Diagnosis: regresses

ovarian follicle cyst: in the middle of the menstruationlutein cyst: before the upcoming period

Ultrasound Study: confirm the cystic nature of the mass, cannot excludes neoplastic tumor

delayed menses / abnormal uterine bleeding / abdominal pain differentiate with ectopic pregnancy, salpingo-oophoritis, or torsion of a neoplastic cyst.

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painful, multilocular / Surgical Explorationpartially solid

Management


child-bearing, <6 cm Reexamination (oral contraceptive)

6 cm to 8 cm / fixed / Ultrasound study feels solid

> 40 years Observation not recommanded

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Management


Surgical Exploration:

Laparoscopy Laparotomy

ovarian cystectomy

Laparoscopic inspection may not be helpful in differentiating between a functional and a neoplastic ovarian cyst.

An aspiration of a unilocular cyst and cytologic examination of the fluid may be misleading, and slow leakage of the fluid will disseminate cancer quite rapidly if the cyst is malignant.

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Epithelial Ovarian Neoplasms

mesothelial cells

cervical epithelium

endometrium ciliated endosalpinx

serousmucinous endometrioid

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•Serous ： 10% bilateral, 70% benign, 5-10% borderline, 20-25% malignant

Epithelial Ovarian Neoplasms

Histologic Features:

•Mucinous: huge size, multilocular, 85% benign

•Brenner: solid benign

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fibromas

granulosa-theca cell tumors

Sertoli-Leydig cell tumors

gynandroblastomas

Sex Cord-Stromal Ovarian Neoplasms

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Sex Cord-Stromal Ovarian Neoplasms

Granulosatheca Cell Neoplasms ： any age group feminizing effects

Sertoli-Leydig cell tumors ： virilizing effects

Ovarian Fibroma： Meigs’ syndrome

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Germ-Cell TumorsBenign Cystic Teratoma 15-20% bilateral all adult tissues

primarily of skin and the dermal appendagessweat and sebaceous glands

hair follicles

Other tissue components: mature brain,

bronchus, thyroid,

cartilage, bone.

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Clinical Features: nonspecific

Diagnosis of Benign Ovarian TumorsSymptoms

most benign ovarian neoplasms are asymptomatic

Torsion: pain, nausea, vomiting Rupture:

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Bimanual pelvic examination: adnexal mass

Signs and Investigations

Diagnosis of Benign Ovarian Tumors

Abdominal examination: lower abdominal mass peritoneal irritation

Pelvic Ultra-Sonography:

exclude malignancy Serum CA 125:

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Confirmed Diagnosis of an Ovarian Neoplasm

Management of Ovarian Neoplasms

Definitive Treatment：

by surgical exploration and microscopic examination

the type of neoplasm

the patient's age

her desire for future child bearing

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Epithelial ovarian neoplasms:

Management of Ovarian Neoplasms Epithelial ovarian neoplasms

young and nulliparous, unilocular, no excrescences

unilateral salpingo-oophorectomy

carefully inspect the contralateral

ovarian cystectomy

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child-bearing women: salpingo-oophorectomy

Management of Ovarian Neoplasms Stromal-Cell Neoplasms

postmenopausal women:

hysterectomy & bilateral salpingo-oophorectomy

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Management of Ovarian Neoplasms Germ-Cell Tumors

ovarian cystectomyunilateral salpingo-oophorectomy

carefully inspect the contralateral

Cystic teratomas

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Benign Tumors of the Fallopian Tubes: inflammatory (hydrosalpinx or pyosalpinx) benign neoplasms of the oviducts

Benign Tumors of the Fallopian Tubes

difficult to differentiate on examination

definitive treatment: salpingectomy represents

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Parovarian neoplasms

generally small

located within the broad ligament

derived from paramesonephric structures

resect the cystic mass

Parovarian Neoplasms

Benign Tumors

Health & Medicine

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